Provider Demographics
NPI:1114033040
Name:LAM, JASON TAI PANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TAI PANG
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-621-7733
Mailing Address - Fax:808-621-7799
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-621-7733
Practice Address - Fax:808-621-7799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD11212207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine